Can a breastfeeding woman take antihistamines, such as Benadryl (diphenhydramine) or Claritin (loratadine), while breastfeeding?

Antihistamines During Breastfeeding

Yes, breastfeeding women can safely take antihistamines, with second-generation antihistamines like loratadine (Claritin) being preferred over first-generation antihistamines like diphenhydramine (Benadryl) due to fewer sedating effects and better safety profiles.

Recommended Antihistamine Choices

First-Line Options: Second-Generation Antihistamines

• Loratadine and cetirizine are first-line options for allergy treatment during breastfeeding based on available safety data 1
• These medications transfer into breast milk in minimal amounts, with relative infant doses well below the 5% safety threshold (loratadine specifically ranges from 0.3-4.5% depending on the specific antihistamine studied) 2
• Second-generation antihistamines are currently allowed during breastfeeding and are preferred over first-generation options because they generate fewer side effects 3

Second-Line Options: First-Generation Antihistamines

• Diphenhydramine (Benadryl) can be used but requires more caution due to sedating effects that may affect both mother and infant 4
• The FDA label for diphenhydramine explicitly states to "ask a healthcare professional before use" if breastfeeding 4
• First-generation antihistamines like triprolidine are considered compatible with breastfeeding by the American Academy of Pediatrics and should be used when second-generation options are not suitable 5

Safety Profile and Infant Exposure

Minimal Milk Transfer

• All studied antihistamines show relative infant doses below 5%, which is considered the safety threshold for breastfeeding medications 2
• Low levels of pseudoephedrine, triprolidine, and loratadine reach breastfed infants based on human studies 5
• All antihistamines are considered safe to use during breastfeeding, as minimal amounts are excreted in breast milk and would not cause adverse effects on breastfeeding infants 6

Monitoring Recommendations

• Watch for paradoxical central nervous system stimulation from antihistamines, including irritability and insomnia in the infant 5
• Infants may experience unusual drowsiness, particularly with first-generation antihistamines like diphenhydramine 4
• Exercise extra caution with infants less than 6 weeks of age (corrected for gestational age) due to immature hepatic and renal function 7

Practical Prescribing Guidelines

Dosing Strategy

• Take medication immediately after breastfeeding to minimize infant exposure at the next feeding 5
• Use the lowest effective dose for the shortest duration necessary 5
• Avoid combination products that contain multiple active ingredients (decongestants, aspirin, caffeine, alcohol) when possible 5

Special Considerations

• Many liquid cough and cold products contain alcohol, which should be avoided 5
• If using combination products, be aware that decongestants may cause irritability and insomnia in infants 5
• There is no need to pump and discard breast milk after taking antihistamines at recommended doses 8

Common Pitfalls to Avoid

• Do not unnecessarily avoid antihistamines due to overly cautious product labeling—the FDA label for loratadine states "ask a health professional before use" if breastfeeding 9, but this reflects regulatory caution rather than evidence of harm
• Avoid first-generation sedating antihistamines as first-line therapy when second-generation options are available and appropriate 3
• Do not use combination products when a single-ingredient antihistamine will suffice 5
• Be particularly vigilant with very young infants (under 6 weeks corrected age) and watch for excessive drowsiness or feeding difficulties 8